H/O Lecture 1-2: Anemias | Quizlet

Anemia

group of diseases characterized by a decrease in hemoglobin or lack of RBCs which lead to a decreased oxygen carrying capacity

What is the typical lifespan of an RBC?

120 days

What are the s/sx of iron deficiency anemia?

Fatigue

SOB

Dizziness

Pallor

RLS

Tongue inflammation

Lip inflammation

Pica

Ice eating

Concave nails

What labratory values should be drawn to assess the presence and type of anemia?

CBC

Reticulocyte count

Iron profile

Folate

B12

Fecal occult blood test

Hemoglobin (Hb)

protein within RBCs that are responsible for oxygen delivery to tissues

What Hb levels indicate anemia?

Men: <13 g/dL

Women: <12 g/dL

Hematocrit

volume of RBCs compared to the total volume of blood

What are the normal levels of hematocrit?

Men: 40-54%

Women: 36-48%

RBC Count

count of RBCs per unit of blood

What is the normal RBC count?

Males: 4.7-6.1 x10^6

Females: 4.1-5.1 x10^6

Mean Corpuscular Volume (MCV)

average WBC size

What is the normal value of MCV?

80-100 fL

Mean Corpuscular Hemoglobin (MCH)

hemoglobin amount per red blood cell

What is the normal value of MCH?

27-31 pg/cell

What is the normal value of MCHC?

32-36 g/dL

Mean Corpuscular Hemoglobin Concentration (MCHC)

concentration of Hb per volume of cells

Why is the MCV lab value helpful?

determines whether cells are macrocytic, normocytic, or microcytic

What does the MCH value tell us?

helps determine microcytosis or macrocytosis

What does the MCHC value tell us?

helpful for distinguishing microcytosis vs. hypochromia

Reticulocyte count

measurement of erythrocyte precursors to measure ability of the body to produce new RBCs

When would a reticulocyte count be high?

acute blood loss

hemolytic anemia

When would a reticulocyte count be low?

Iron deficiency

B12 deficiency

Renal insufficiency

RBC Distribution Width (RDW)

measures the variety of how much and what size of RBCs

What is the normal RDW?

11.5-14.5%

Serum iron

circulating iron bound to transferrin

Serum ferritin

iron stored in the liver, spleen, and bone marrow

What are the normal serum ferritin levels?

Males: 20-300 ng/mL

Females: 15-200 ng/mL

What is the normal serum iron levels?

Males 65-176 mcg/dL

Females: 50-170 ng/mL

Total Iron Binding Capacity (TBIC)

measures the capacity of transferrin to bind iron

Transferrin Saturation (TSAT)

ratio of serum iron to TBIC - indicated how much iron-binding sites are occupied on transferrin

What is the normal TBIC levels?

250-450 mcg/dL

What is the normal TSAT levels?

20-50%

What MCV value indicates microcytic anemia?

<80 mg/dL

What MCV value indicates normocytic anemia?

80-100 mg/dL

What MCV value indicates macrocytic anemia?

>100 mg/dL

What is the most common cause of microcytic anemia?

Iron deficiency

Who is at high risk for IDA?

Children <2 y/o

>65 y/o

Adolescent girls

Pregnant/lactating

Bloos loss

Altered gut absorption

Low meat diet

Iron deficiency anemia (IDA)

prolonged periods of iron deficiency from increased demand, blood loss, or decreased dietary intake/absorption of iron

Ferritin

HIGHLY soluble form of iron that is stored in the liver, spleen, serum, and bone marrow

Hemosiderin

INsoluble form of iron that is primarily stored in the liver and bone marrow

What are the stages of IDA?

1. Decreased bone marrow stores

2. Impaired erythropoesis

3. Hgb falls below normal limits

4. Microcytosis and hypochromia develop

5. Iron deficiency and low hemoglobin affect the body

As transferrin increases, what happens to serum iron levels?

decrease

As transferrin decreases, what happens to serum iron levels?

increases

What is used to rule IN IDA?

Ferritin <30 ng/mL

What is used to rule OUT IDA?

Ferritin >100 ng/mL

What lab values are DECREASED in IDA?

Hgb/Hct

MCV

Serum Fe (low or normal)

Ferritin

TSAT

What lab values are INCREASED in IDA?

TBIC -

What is the PO iron therapy recommendation for IDA?

120mg of elemental iron per day for 3 months

What shows an adequate response to PO iron therapy?

Hgb increase of 1 g/dL after 1 month

Normal ferritin levels

Men: 20-500 mg/dL

Women: 20 -200 mg/dL

ADRs of PO iron therapy

Dark Stools

GI upset

Nausea

Diarrhea/constipation

What is the amount of elemental iron in ferrous sulfate?

20%

What is the amount of elemental iron in ferrous gluconate?

12%

What is the amount of elemental iron in ferrous fumarate?

33%

What foods should be avoided with PO iron?

Milk

Calcium

High fiber foods

Caffeine

Can PO iron be taken with food?

Yes, but decreases absorption by ~40%

What medications decrease the absorption of PO iron?

Tetracyclines

Fluoroquinolones

Antacids/PPIs/H2 blockers

Multivitamins

What can help to increase the absorption of PO iron?

Vitamin C

Empty stomach

Every other day dosing

Which drugs are affected by iron?

Levodopa

Methyldopa

Levothyroxine

Quinolones

Tetracyclines

Doxycycline

How should medications that interact with iron be taken?

separate by at least 2 hours

Levothyroxine - separate by 4 hours

What is the percentage of elemental iron in ferric maltol?

100%

When is IV iron preferred over PO iron?

Intolerance to PO

Impaired iron absorption

Rapid blood loss

CKD

Why is IV iron superior to oral iron?

sustained Hb response and reducing the need for blood transfusions

What are the biggest ADRs of IV iron?

Infusion related reactions

Anaphylactic reactions

Which IV iron formulation requires test doses due to high rates of anaphylaxis reactions?

Iron Dextran (BBW)

Which IV iron formulation is given in a series of small doses over days to weeks?

Iron sucrose

Which IV iron formulation is commonly used in dialysis patients?

sodium ferric gluconate

Which IV iron formulation can be infused quickly?

Ferumoxytol

Which IV iron formulation needs to be infused over 1 hour?

Sodium ferric gluconate

IV Iron formulations

Iron sucrose (Venofer)

Iron Dextran (Infed)

Sodium ferric gluconate

Ferumoxytol

PO Iron formulations

Ferrous sulfate

Ferrous gluconate

Ferrous fumarate

Ferric maltol

What are the best markers for detecting iron deficiency in heart failure?

TSAT <20%

<10% of bone marrow erythroblasts containing iron

Which iron formulations are preferred in heart failure?

Iron sucrose

Ferric carboxy maltose

Ferric gluconate

What are the caues of microcytic anemia?

Iron deficiency

Sideroblastic anemia

Thalassemia

Lead poisoning

What are the caues of macrocytic anemia?

Vitamin B12 deficiency

Folate deficiency

Liver disease

Drugs

What are the caues of normocytic anemia?

Anemia of CKD

Sickle cell

Aplastic anemia

Hemorrhage

Where are folate and vitamn B12 absorbed?

Small intestine

Jejunum (folate)

Terminal ilium (B12)

Pernicious anemia

autoimmune disorder where autoantibodies target intrinsic factor

Which drugs can cause folate deficiencies?

Methotrexate

Bactrim

Which drugs can cause B12 deficiencies?

Metformin

PPIs

H2 Receptor blockers

Chemotherapy

What can cause folate deficiencies?

Alcohol

Poor diet

Bariatric surgery

Celiac

Methotrexate

Bactrim

Pregnancy

What can cause B12 deficiencies?

Vegan

Pernicious anemia

Bariatric surgery

Celaic

Metformin

PPI

H2RAs

Pernicious anemia can cause what deficiency?

Vitamin B12

What labs can be used to differentiate between folate and vit B12 anemias?

Folic acid

Methylmalonic Acid

How do the folic acid levels differentiate between vit B12 and folate deficiency anemias?

Folate - decreased levels

B12 - normal levels

How do the methylmalonic acid levels differentiate between vit B12 and folate deficiency anemias?

Folate - normal levels

B12 - increased levels

What are the s/sx of folate deficiency anemia?

Fatigue

Oral Ulcers

Neural tube defects in fetus

Neuropsych changes

What are the s/sx of B12 deficiency anemia?

Glossitis (tongue inflammation)

Reduced sensation/ tingling

Decrased cognitive function

What is the onset of folate and B12 deficiencyes?

Folate - weeks to months

B12 - years

What is the treatment of B12 deficiency anemia?

Vitamin B12 (IM, SQ, or PO)

ADRs of B12

Headache

Infection (if injection)

Fatigue

What is the treatment for folate deficiency?

folic acid

What is the repletion dose of folic acid?

1000-5000 mcg PO QD

What is the maintenance dose of folic acid?

400 mcg PO QD

Why is it important to supplement with folate in pregnancy?

risk of neural tube defects

What is the recommendation of folate supplementation in pregnancy?

400-800 mcg PO QD

Why does chronic kidney disease cause normocytic anemia?

decreased erythropoietin production

Can blood transfusions be used in CKD patients with anemia?

should be avoided to minimize risk of rejection (HLA sensitization)

When would a transfusion be allowed for an anemic CKD patient?

when the patient requires stabilization

Erythropoiesis Stimulating Agents (ESAs)

Epoetin Alfa

Darbepoetin alfa